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Povidone iodine and skin disinfection before initiation of epidural anesthesia
D J Birnbach1, D J Stein, O Murray
1Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, New York, New York 10019, USA. djb2@columbia.edu
Background:
Povidone iodine (PI) solution is used commonly for skin disinfection before epidural and spinal anesthesia. Although there have been reports indicating the presence of microbial contaminants in PI solution, none have evaluated the prevalence of PI contamination. The aims of this study were to assess the frequency of bacterial contamination of previously opened bottles of PI solution and to compare the effectiveness of new and previously opened bottles of PI solution for skin disinfection.
Methods:
Twenty previously opened and ten previously unopened multiple-use bottles of PI solution were evaluated for microbial contamination. In addition, final swabs and PI solution used for skin disinfection in 80 patients undergoing elective epidural analgesia were evaluated.
Results:
The inside of the bottle cap or the PI solution from 40% of the multiple-use PI bottles in use were contaminated. There was no growth from any previously unused PI bottles. Povidone iodine from newly opened bottles provided more effective skin decontamination than did solution from previously opened bottles.
Conclusions:
Multiple-use PI bottles in normal use may become contaminated by bacteria. In addition, PI solution from previously opened bottles was less effective than PI from previously unopened bottles. Based on these findings, if PI solution is chosen for skin antisepsis before initiation of epidural and spinal anesthesia, only single-use containers should be used.
Insights
Previously opened povidone iodine (PI) bottles are frequently contaminated with bacteria, reducing their effectiveness for skin disinfection. For safer procedures like epidural anesthesia, always use single-use PI containers.
Area of Science:
- Microbiology
- Anesthesiology
- Infection Control
Background:
- Povidone iodine (PI) is a standard skin disinfectant before neuraxial anesthesia.
- Concerns exist regarding microbial contamination of multi-use PI bottles.
- Prevalence of PI contamination and its impact on efficacy were previously unevaluated.
Purpose of the Study:
- To determine the frequency of bacterial contamination in opened PI bottles.
- To compare the skin disinfection effectiveness of new versus previously opened PI bottles.
Main Methods:
- Microbial analysis of 20 opened and 10 unopened PI bottles.
- Evaluation of skin disinfection in 80 patients undergoing epidural analgesia using final swabs and PI solution.
Main Results:
- Bacterial contamination was found in 40% of opened PI bottles.
- No contamination was detected in unopened PI bottles.
- PI from new bottles demonstrated superior skin decontamination compared to opened bottles.
Conclusions:
- Multi-use PI bottles are susceptible to bacterial contamination during normal use.
- Opened PI bottles exhibit reduced efficacy for skin antisepsis.
- Single-use PI containers are recommended for skin antisepsis before epidural and spinal anesthesia.